Medications for Parkinson's Disease

The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines only as recommended by your doctor and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Medicines for
Parkinson’s disease
work in a variety of different ways. The primary strategy is to increase the amount of dopamine or to activate the dopamine receptor, as it is the neurotransmitter pathway that is decreased in patients with Parkinson’s disease. Although most patients respond to medicines initially, the effects may wear off over time as the disease progresses. When a particular medicine stops working, your doctor may have to increase the dose, switch medicines, stop and then restart a medicine, or add on another medicine.
In addition, many people experience disabling side effects (specifically, rapid “wearing-off” of the drug and abnormal movements, called
dyskinesias) from long-term dopamine-replacement therapy, which requires a decrease in dose and possible substitution of another medicine or other form of therapy.

Prescription Medications

Levodopa

Levodopa is the most effective treatment for symptoms. It is a precursor to dopamine and converted to dopamine once transported into the brain.

Common names include:

Dopar

Larodopa

Levodopa and Carbidopa

Common names include:

Carbidopa/levodopa
(Sinemet)

Carbidopa/levodopa controlled-release (Sinemet CR)

Carbidopa/levodopa/entacapone (Stalevo)

Levodopa helps increase the amount of dopamine within the brain. This can help improve symptoms of Parkinson’s disease, particularly rigidity and slowness. Unfortunately, the body metabolizes (breaks down) this drug very quickly, so you’ll have to take another dose fairly often. As a result, you’ll often be given a medicine that combines levodopa with carbidopa, a substance that slows the breakdown of levodopa. You’ll only have to take this medicine every 4-6 hours.

If you’re taking levodopa alone, don’t take
vitamin B6
supplements without your doctor’s knowledge since they can speed up the breakdown of levodopa. Because bananas, egg yolks, lima beans, meats, peanuts, and whole grain cereals all contain large amounts of vitamin B6, ask your doctor how much of these food items you should eat on a daily basis.

Some people notice less effect from levodopa and levodopa/carbidopa combinations over time. The drugs may seem less effective, or their benefits may stop even before it’s time for the next dose. If this happens, talk to your doctor about increasing the dosage or increasing how frequently you take the medicine.

Stalevo adds entacapone, a COMT inhibitor (see
below), to the levodopa/carbidopa combination. Side effects are reported to be those described above, plus those listed below for entacapone (Comtan).

Dopamine Agonists

Common names include:

Bromocriptine
(Parlodel)

Cabergoline
(Dostinex)

Pramipexole
(Mirapex)

Ropinirole
(Requip)

Apomorphine
(Apokyn)

Rotigotine (Neupro) patch

These drugs affect the brain in a way similar to dopamine. They may be given by themselves early in Parkinson’s disease, or along with other medicines (like levodopa) later in the course of the disease. Dopamine agonists cause less motor fluctuations and dyskinesias due to the longer duration of action.

Some people develop hallucinations or confusion while taking dopamine agonists and have to stop taking the medicine. Do not use alcohol while you are taking a dopamine agonist. You will have unpleasant and potentially dangerous symptoms, including nausea, vomiting, fast heart rate, blurry vision, chest pain, headache, and extreme weakness.

Sudden low blood pressure when you first stand up (which can result in falling)

Sudden sleep attacks (These attacks can be very dangerous if they occur while you’re driving.)

Hallucinations, delusions

Compulsive gambling

Other Side Effects

Apomorphine (Apokyn) is a short acting dopamine agonist given as an injection in advanced cases. The medicine was approved by the FDA for wearing-off spells. These spells occur in patients who have been receiving long-term dopamine replacement therapy. The side effects are similar to that of the dopamine agonists. But, nausea and vomiting have been reported to occur more often.

Cabergoline
(Dostinex) has also been associated with the risk of serious heart damage. The dopamine agonist bromocriptine (Parlodel) has rare, but significant, side effects (such as pericardial, pleural, and
pulmonary fibrosis). Talk to your doctor if you have been taking these medicines and are concerned about potential side effects.

Monoamine Oxidase Type B Inhibitor

Common brand names include:

Selegiline
(Eldepryl)

Rasagiline (Azilect)

Selegiline and rasagiline are usually given along with levodopa or levodopa/carbidopa combinations. Both interfere with the breakdown of dopamine in the brain.

You may have a severe reaction if you take this medicine along with the narcotic painkiller,
meperidine
(Demerol).

If you are taking selegiline at higher-than-usual doses, you may have a sudden, dangerous spike in blood pressure if you eat or drink things that contain a substance called tyramine. Tyramine is found in:

These medicines can decrease tremor and stiffness and improve muscle control.

You’ll have less chance of stomach irritation if you take these medicines with food. Don’t take an anticholinergic medicine within the hour after you’ve taken medicine for diarrhea; the diarrhea medicine will interfere with the actions of the anticholinergic medicine. Don’t use alcohol while you're taking anticholinergic medicines. Check with your doctor before using any medicines that make you drowsy.

Before you begin treatment with anticholinergic medicines, get your eyes checked by an ophthalmologist.

Possible side effects include:

Drowsiness

Dizziness

Sensitivity to bright lights

Dry mouth

Urinary retention

Blurred vision

Constipation

Fast heartbeat, palpitations

Mood changes

Memory difficulties

Confusion

Hallucinations

Amantadine

Common brand name:

Amantadine
(Symmetrel)

Amantadine can help reduce stiffness and tremor and improve muscle control. Sometimes this medicine stops working after you’ve been taking it for a while. Your doctor may recommend that you take a break (a “drug holiday”) from the medicine and then restart it. This may help the drug regain its effectiveness.

Don’t drink alcohol while you’re using amantadine. If you begin to feel
depressed
or suicidal, talk with your doctor right away.

Possible side effects include:

Dizziness, especially when first rising (which may increase risk of falls)

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.